Child Sexual Abuse Prevention Programs

Kim Lilly

Problem

Before exploring the issue of sexual abuse prevention programs, it is
important to understand the definition of the term sexual abuse. There
are several definitions that could be used to define the term. Several
researchers conclude that when defining abuse it is important to put age
restrictions on what constitutes abuse. Some say, if the perpetrator is
five years older than the pre-teen victim, then the act is considered abuse.
Whereas, if the victim is a teenager, a 10 year age difference is required
for the act to be considered abuse (Knutson, 1995). These age ceilings
can vary by research group. In some research studies it is considered sexual
abuse with anyone under the age of 18, whereas in others the age range
varies between 14 and 16. For the purposes of this paper the following
definition will be used: Sexual abuse is when an adult or a child who is
five years older than the victim engages in sexual behavior which includes
kissing, fondling, touching, petting, oral sex, penetration of anus or
vagina, prostitution of the child, taking nude pictures of the child or
showing pornography to the child who is under the age of 18 (Conte, 1993).
Victimization of children involves abuse of power and control by an adult.
Abuse usually occurs in a familiar setting and with someone who the child
has already developed a special bond or attachment (Lanning & Ballard
& Robinson, 1999).

Most experts would say that sexual abuse occurs much more often than
the statistics report. According to the research the estimates range from
6% to 62% for females and 3% to 31% for males (Conte, 1993). There could
be several reasons for the wide gaps in these percentages. For example,
the methods used to obtain the information such as the attributes of the
sample or the wording on the questionnaire. By testing these methods, the
margin of error could be reduced resulting in more accurate measures.

Victims of sexual abuse are affected in many ways. In a study of 156
sexually abused preschool students, those that were abused scored higher
than a norm group on the Louisville Behavior Checklist (LBC) on 10 out
of 16 areas (Conte, 1993). Adolescents scored higher than the norm group
on all areas of the LBC (Conte, 1993). Research has shown many children
who have been sexually abused have 20 to 30 percent smaller brains than
those children who have not been abused (Lowenthal, 1999). Other implications
of experiencing sexual abuse include problems with academics, difficulty
adjusting to social situations, lower self esteem, lower self image, lack
of motivation, some emotional and behavioral problems and attention problems.(Meston
et al, 1999). Victims of sexual abuse tend to seek out the approval of
the teacher and need constant assurance and approval (Lowenthal, 1996).
In addition, these children have a greater tendency to exhibit sexual promiscuity
and severe sleeping problems (Conte, 1993).

As public awareness about the severity of sexual abuse increases, it
is becoming clear that simply identifying the problem and responding to
crises is not the answer. Experts in the field have been trying to develop
prevention programs that can empower and educate children about sexual
abuse since the 1970's. Due to the regular and long-term contact school
has with families and children, the school setting is an ideal forum for
empowering and educating children about sexual abuse. These programs give
children knowledge about sexual abuse and teach students mechanisms for
responding to potential danger and traumatic events. The children learn
about "good" and "bad" touching, ideas related to self-esteem and the ability
to say "no". In addition, children learn what the definition of child abuse
is and the proper steps to take if it ever occurs to them. In addition,
they learn the need for safety plans if the child is in an abusive relationship
with an adult. Some programs stress the idea that the children themselves
are in control of their bodies, and therefore, they control what happens
to it. This model attempts to empower children to take control of their
lives.

The behavioral model is used in the majority of sexual abuse prevention
programs. These programs focus on reframing the ideas of trust, boundaries
and control within the child. They often use modeling of appropriate and
inappropriate behaviors. This behavioral skills training (BST) focuses
on teaching, role-playing and feedback. It is usually used in connection
with group discussion, plays, videos and workbooks (Berson & Berson,
1999).

To summarize sexual abuse is a significant problem. There are several
definitions that researchers use when defining sexual abuse. Each has different
age differentials for determining when an act is considered abuse. There
should be a standard definition used so that the research is more consistent.
Also, the assessment tools for determining the prevalence of sexual abuse
need to be adjusted to elicit more accurate responses. This would help
close the wide gaps in statistical percentages. However, from just looking
at the lowest percentage, it is clear that sexual abuse affects many children.
Prevention programs are to give children information about sexual abuse
and ways to avoid uncomfortable situations. The focus is to empower children
to take control and stand up for themselves in those certain situations
as well as educating the child about the issue.

Literature

In the research reviewed for this paper, almost every article mentioned
that there are a lot of inconsistencies about the issue of sexual abuse.
Research cautions that statistics on child sexual abuse are controversial,
and that most statistics will be debated by another expert in the field.
(Hopper, 1998). Many of the findings of the sexual abuse research have
not been backed up by measurement.

Research that deals with sexual abuse prevention programs in the school
system are fairly consistent in their findings. However, there are several
issues that research has pointed out regarding prevention programs. These
issues include age appropriate material, training of the presenter, side
effects of the program and assessment techniques.

It is imperative that the material presented is age appropriate. Sexual
abuse prevention programs are available to children from pre-school to
high school students. However, the majority of these programs are implemented
at the elementary level (Roberts & Miltenberger & Raymond, 1999).
Therefore, the information needs to be presented in a way that the children
can understand. Material should focus on more concrete ideas rather than
abstract ideas and should use repetition when ever possible. It is difficult
for younger children to understand the terms "good" and "bad", especially
when the person that is abusing the child has been known as a "good" person
to them for so long (Roberts & Miltenberger & Raymond, 1999). This
makes it difficult for a small child to differentiate what good and bad
touching is particularly when the abusers try to use good touching in the
beginning to lure the victims. Another age appropriate issue is that adults
are constantly telling children to respect their elders, in most cases
this is a sound request. However, in instances of abuse many children are
getting a mixed message (Conte, 1993). This makes it even harder for children
to understand the information presented in the prevention programs. Therefore,
it is the responsibility of the program to give a clear definition and
assess the student's knowledge after the program to make sure they have
a good understanding of the material.

Research points out that the ability of the facilitator and the question
of who should facilitate the groups is an important factor in the effectiveness
of the program. The facilitator need to be highly trained in the area of
sexual abuse. Several programs have had the classroom teacher, parent or
an expert in the field present the information. One author questioned the
ability of parents to be effective facilitators. In programs where a parent
was used to facilitate, the children did not show a good understanding
of the information presented (Roberts & Miltenberger & Raymond,
1999). Research has shown that the best combination is when the parent
works with the child at home on the information that was presented in the
program by a teacher or an expert (Roberts & Miltenberger & Raymond,
1999). Considering that the teacher already has a strong bond with the
child, the teacher might be the best facilitator for these programs. However,
just because teachers have a close bond with most of the kids in their
classes does not mean that they know a lot about sexual abuse. Teachers
would have to be trained on facilitating this type of program.

Research does not focus on the school social worker as playing a role
in sexual abuse prevention programs. School Social Workers can be trained
as facilitators, considering they have a particular interest in children
who have been sexually abused and they should already have a background
in the area of abuse. They are in contact with the child, parent and teacher
and could easily inform and educate all parties involved on the program.
This would engage the whole system in the prevention of sexual abuse. Children
who are informed about sexual abuse, and have informed parents, are in
much more control of the situation. It is important to educate the parents
or caretakers about the prevention of sexual abuse and possible signs or
symptoms related to it such as: complaints of burning, itching or bruising
in the genital area, bloody stools or vaginal bleeding, alluring sexual
behavior towards peers or an abrupt behavior change ( Lowenthal, 1996).

Prevention programs could produce side effects in some children who
go through the program. Some children who completed a prevention program
experienced an increased fear of strangers, increased anxiety, nightmares
and behavioral problems. Prevention programs have been trying to combat
this issue by implementing assessment tools to ensure that the children
understand the basic concepts. Assessment tools that are commonly used
are pre and post tests, Lichert scales, giving examples of an abusive or
non-abusive situation, and asking the child what they would do in that
situation, such as the "What If" questions (Berson & Berson, 1999).
Some programs use more sophisticated assessment tools such as the State-
Trait Anxiety Inventory for Children, The Children's Knowledge of Abuse
Questionnaire (CKAQ) and The Personal Safety Questionnaire (PSQ) (Roberts
& Miltenberger & Raymond, 1999).

Though there are a number of factors affecting the outcome of these
prevention programs, research has shown that they have met the goal of
educating children about sexual abuse and empowering them with mechanisms
to combat the problem (Conte, 1993; Roberts & Miltenberger & Raymond,
1999; Lanning & Ballard & Robinson, 1999). Research does not focus
on assessing the impacts or knowledge base several years after the child
has gone through the program. If the child went through a prevention program
when they were in the third grade, it is highly unlikely that they will
remember the information when they are in the tenth grade. In order for
the program to be effective, the child must be exposed to the program several
times throughout their education.

The research did not focus on cultural affects of the program, for instance,
whether African American children have better results than Caucasian or
Hispanic children. It would be interesting to see if the program is culturally
sensitive, by comparing the outcomes of different cultures.

Practice and Policy Implications

Schools need to take some responsibility in preventing the sexual abuse
of children. They need to implement sexual abuse prevention programs in
the schools. School districts need to encourage each school to implement
a prevention program and allocate money in order to fund the program. For
example, in the state of Texas, 89 schools out of 110 have implemented
a prevention program (Lanning & Ballard & Robinson, 1999).

This issue of preventing sexual abuse is extremely important to school
social workers. They come in contact with victims of sexual abuse and have
a particular interest in helping them adjust. They should be trained to
facilitate these programs, focusing on both teaching and helping children
with various problems. They are often in charge of implementing in various
programs, such as Peer Mediation Programs, where peers try to work out
their own problems with the help of a peer mediator, or programs about
dealing with grief and loss like Rainbows. They are usually adept at presenting
these programs and could easily fit into the role of facilitator of a sexual
abuse prevention program. They collaborate with parents and teachers and
can give them tools for assessing abuse in the classroom and at home. This
type of training would only add the the social workers knowledge base.

As the research has indicated, teachers and experts in the field have
been good facilitators of this type of program. However, teachers already
have so much to deal with in the classroom on a daily basis. In addition,
there are more behavioral, emotional and attention problems than in years
past requiring teachers to spend more time on lesson plans and controlling
the climate of the classroom. Many teachers are already implementing so
many programs into their curriculum that they do not have time to execute
and organize a new program. The school district could hire an expert in
the field to facilitate the groups, though the children would not be familiar
with that person. When discussing a topic so personal and private, it might
be better to utilize a resource in the school setting like the school social
worker that the children are already familiar with. In addition, hiring
an outside could be costly to the already tight budgets of the school system.
Also, it could be too costly to hire an outside expert facilitator to run
the groups. Finally, the program needs to have the support of the families
and the community. The social worker and the classroom teacher usually
have a good working relationship with the parents of the children. This
allows them to explain the importance of the program, as well as, describe
the curriculum of the program to parents.

Conclusion

In closing, it is important to know that statistics on sexual abuse
can be misleading. Many sexual abuse cases are not reported making the
stats much lower than actual incidents of sexual abuse. There are often
wide gaps in the percentages when dealing with the frequency of abuse.
These wide gaps can often be explained by the wording used on assessment
tools, varying definitions that define sexual abuse and the under reporting
of sexual abuse. Victims experience a wide array of problems ranging from
psychological to academic issues in school. Their experience can be manifested
by increases in behaviors, emotions and lower self-esteem. Several studies
show that children who have been sexually abused tend to score higher on
maladaptive behavior scales. Sexual abuse prevention programs help children
to learn about sexual abuse and they learn mechanisms to help them in an
uncomfortable situation. It is important to implement these programs into
school systems. By utilizing the school social worker as facilitators of
the program, the school is maximizing its resources.